> ## Documentation Index
> Fetch the complete documentation index at: https://help.clinikehr.com/llms.txt
> Use this file to discover all available pages before exploring further.

# Modalities

> Register each imaging machine with a private bridge key so finished studies attach themselves to the right order, and review the ones that don't.

export const AuditNote = ({action = 'This action'}) => <div className="ck-callout ck-callout--info" role="note">
    <p className="ck-callout__body">
      {action} is written to your workspace's audit log with your name, the
      record touched and the time — a HIPAA requirement, and one you can review
      yourself under <strong>Audit Log</strong>. See{' '}
      <a href="/platform/security/audit-log">Audit log</a>.
    </p>
  </div>;

export const StillStuck = ({topic}) => <div className="ck-callout ck-callout--note" role="note">
    <p className="ck-callout__body">
      <strong>Still stuck{topic ? ` with ${topic}` : ''}?</strong>{' '}
      Check <a href="/platform/help/troubleshooting">Troubleshooting</a> first —
      it covers the failures we see most often. If that does not resolve it,{' '}
      <a href="/platform/help/contact-support">contact support</a> and include
      your workspace name and the time the problem happened, so we can find the
      matching entry in your audit log.
    </p>
  </div>;

export const TaskHeader = ({before, time, after}) => <div className="ck-task">
    {before ? <div className="ck-task__cell">
        <div className="ck-task__title">Before you start</div>
        <p className="ck-task__body">{before}</p>
      </div> : null}

    {time ? <div className="ck-task__cell">
        <div className="ck-task__title">Takes about</div>
        <p className="ck-task__body">{time}</p>
      </div> : null}

    {after ? <div className="ck-task__cell">
        <div className="ck-task__title">When you're done</div>
        <p className="ck-task__body">{after}</p>
      </div> : null}
  </div>;

export const Path = ({steps = []}) => <span className="ck-path">
    {steps.map((s, i) => <span key={i} className="ck-path__step">
        {i > 0 ? <span className="ck-path__sep" aria-hidden="true">
            ›
          </span> : null}
        {s}
      </span>)}
  </span>;

export const Availability = ({editions = ['all'], plans, roles, note}) => {
  const list = editions.includes('all') ? ['clinic', 'pharmacy', 'lims'] : editions;
  return <div className="ck-avail" role="note" aria-label="Feature availability">
      <span className="ck-avail__label">Available in</span>

      {list.map(e => <span key={e} className={`ck-pill ck-pill--${e}`}>
          {EDITION_LABELS[e] || e}
        </span>)}

      {plans ? <span className="ck-avail__label">Plan</span> : null}
      {plans ? <span className="ck-pill ck-pill--plan">{plans}</span> : null}

      {roles ? <span className="ck-avail__label">Who</span> : null}
      {roles ? <span className="ck-pill ck-pill--role">{roles}</span> : null}

      {note ? <span className="ck-avail__note">{note}</span> : null}
    </div>;
};

<Availability editions={['clinic']} plans="Enterprise" roles="Radiologists, radiology technicians, doctors and managers" note="Needs the Diagnostics care area and the imaging bridge" />

**Modalities** connects your CT, MRI, ultrasound and X-ray machines to ClinikEHR: **Register each imaging machine (or its bridge PC) with a private key. Finished studies with a matching accession attach automatically; anything ambiguous waits below for review.**

<Path steps={['Sidebar', 'Radiology', 'Modalities']} />

<TaskHeader before="The imaging bridge switched on for your hospital, and someone who can configure the machine's bridge PC" time="Five minutes per machine" after="Studies arriving on their orders by themselves, ready to report" />

## Before you start

Without the imaging bridge this page shows a locked card: **Modality integration is a Professional feature**, with "Connect your CT/MRI/US/X-ray machines: orders reach the modality worklist and finished studies attach themselves to the order for reporting." A **View plans** button sits underneath — see [Change your plan](/platform/plans/change-plan). You also need whoever looks after the machine's bridge PC, because half of this task happens there.

<Note>
  Image pixels never leave your building. ClinikEHR stores addresses only, and the viewer reads full-resolution studies from your own on-site archive: "Images never leave the clinic — only these URLs are stored."
</Note>

## What you're looking at

**Register modality** adds a machine; **Refresh** re-reads the page. Four sections follow.

### The modality registry

| Column        | Shows                                                               |
| ------------- | ------------------------------------------------------------------- |
| **Modality**  | The name you gave it                                                |
| **AE title**  | Its DICOM application entity title, the name it announces itself by |
| **Type**      | CT, MR, US and so on                                                |
| **Status**    | **Active** or **Paused**                                            |
| **Last seen** | When it last sent anything — **never** if it has not                |

Before you register anything it reads **No modalities registered yet.** Each row offers **New key** and **Pause** (or **Resume**).

### Studies awaiting review

**These arrived without a matching accession. Attach each to the right order so its images show up for reporting.** Columns are **Received**, **Modality**, **Patient / accession**, **Study** and **Review**, and the healthy state is **Nothing waiting — unmatched studies appear here.**

### The three settings blocks

**Prior-image sources (PACS)** — "When a study arrives, the bridge pulls the patient's priors from these archives for comparison." **Auto-archive to cloud** archives matching studies as they attach, with no per-study click. **Full-resolution viewer (OHIF)** holds the two addresses the report's **Open full viewer** button uses.

## Register a machine

<Steps>
  <Step title="Select Register modality">
    The dialog explains what it is about to do: **A private key is generated for this machine's bridge PC — it authenticates every study it forwards.**
  </Step>

  <Step title="Name it">
    **Name** is the only required field — the example is "CT Room 1". Add the **AE title (optional)** and **Type (optional)** if you know them; both help you tell machines apart later. Select **Register**.
  </Step>

  <Step title="Copy the key and configure the bridge PC">
    The **Bridge key for \{name}** dialog opens. Set the key on the machine's bridge PC as the `X-Modality-Key` header, and copy it before you close the dialog.
  </Step>

  <Step title="Confirm it is talking">
    Once the machine forwards its first study, **Last seen** changes from **never** to a timestamp.
  </Step>
</Steps>

<Warning>
  The bridge key is shown **once**, at the moment it is generated. If it is lost, use **New key** on the row to generate a replacement — which immediately stops the old key working, so the machine will forward nothing until the bridge PC is updated. Never write the key down anywhere shared: it authenticates every study that machine sends.
</Warning>

## Attach a study that arrived unmatched

A study with an exact accession match attaches itself. Everything else waits under **Studies awaiting review**, because guessing which patient an image belongs to is not a thing software should do.

<Steps>
  <Step title="Read the row">
    It shows the modality, the patient name and accession the machine sent, and the study — modality code, image count, series count. A missing name shows as **(no name in study)**, a missing accession as **no accession**.
  </Step>

  <Step title="Select Attach to order">
    The dialog, **Attach study to an order**, names the study's patient and accession. **Search by accession, patient or test…** is pre-filled with whatever the study carried; nothing matching reads **No matching orders awaiting a study.**
  </Step>

  <Step title="Select the order">
    Selecting a row attaches immediately — there is no second confirmation. You get **Study attached — images are now on the order**. Attaching only makes the images viewable; the radiologist still writes the report — see [Radiology reports](/hospital/diagnostics/radiology-reports).
  </Step>
</Steps>

**Discard** removes an unmatched study from the queue **with no confirmation dialog**. Use it only for genuine junk — a test acquisition, a duplicate — and check the row twice first.

## Connect priors, archiving and the viewer

<Steps>
  <Step title="Add a PACS source">
    **Add source** takes a **Name**, an **AE Title**, a **Host** and a **Port** (104 by default) — the archive priors are pulled from. It must be reachable from your own on-site archive. Its status badge toggles **Active** / **Paused** when you select it.
  </Step>

  <Step title="Set an auto-archive policy">
    Switch **Auto-archive to cloud** on, choose which **Modalities to auto-archive** (none selected means all of them) and a **Minimum images** threshold to **Skip trivial studies below this image count**. Select **Save auto-archive policy**.
  </Step>

  <Step title="Point the viewer at your archive">
    Enter the **OHIF viewer URL** and the **Orthanc DICOMweb URL (tunnelled)**, then **Save viewer settings**. That second address is what **Open full viewer** passes the study to.
  </Step>
</Steps>

<AuditNote action="Attaching a study to a patient's order" />

## Who can do this

**Role** decides whether the page opens — owners, managers, radiologists, radiology technicians and doctors pass. Anyone else is told **You don't have permission to manage imaging modalities. Please contact your clinic administrator.** An owner can also hide **Radiology** from a role under [Role navigation](/hospital/settings/role-navigation).

| Action                                   | Who by default                  | How it is governed                                  |
| ---------------------------------------- | ------------------------------- | --------------------------------------------------- |
| See **Modalities** in the sidebar at all | Everyone with Radiology         | Plan — the imaging bridge is a Professional feature |
| Register a machine or generate a new key | Imaging staff, managers, owners | Role                                                |
| Attach or discard an unmatched study     | Imaging staff, managers, owners | Role                                                |
| Add or remove a PACS source              | Imaging staff, managers, owners | Role                                                |
| Change auto-archive and viewer settings  | Imaging staff, managers, owners | Role                                                |

Where per-person permissions apply, enforcement is **opt-in**: someone never saved in the permissions sheet is unrestricted, and the sheet warns **"Saving starts enforcing"**. A **denied action is recorded** in the audit log; an allowed one is not. See [Staff permissions](/platform/team/permissions).

## Check it worked

* The machine appears in the registry as **Active**, and **Last seen** fills in after its first study.
* New studies stop appearing under **Studies awaiting review** — they attach themselves.
* A report for that study shows **\{n} images attached** and offers **Open full viewer**.
* **Prior studies** appears on the report where the patient has earlier imaging.

## Common issues

<AccordionGroup>
  <Accordion title="Modality integration is a Professional feature">
    The imaging bridge is off for your plan, so the page is locked. Everything else in Radiology works without it — you attach images by hand instead. See [Change your plan](/platform/plans/change-plan).
  </Accordion>

  <Accordion title="Last seen still says never">
    The bridge PC is not sending, or the key on it is wrong. Confirm the key is set as the `X-Modality-Key` header, and remember that generating a **New key** invalidates the previous one instantly.
  </Accordion>

  <Accordion title="Everything lands in Studies awaiting review">
    The accession the machine sends does not match the one on the order. Fix that at the machine — attaching by hand every time is a symptom, not a workflow.
  </Accordion>

  <Accordion title="I discarded the wrong study">
    Discard has no confirmation and no undo. The machine can re-send it; the images are still in your own archive, so attach the next copy rather than reporting from memory.
  </Accordion>

  <Accordion title="Open full viewer is missing on reports">
    No viewer address is saved. Fill in **OHIF viewer URL** and **Orthanc DICOMweb URL (tunnelled)** and select **Save viewer settings**.
  </Accordion>
</AccordionGroup>

## FAQ

<AccordionGroup>
  <Accordion title="Does ClinikEHR store our images?">
    No. It stores addresses, plus small preview images for the report. Full diagnostic pixels stay in your own archive and are served from there over your secure tunnel.
  </Accordion>

  <Accordion title="What does pausing a modality do?">
    It stops that machine's studies being accepted while leaving its registration intact. Use it while a machine is being serviced or moved, rather than deleting it.
  </Accordion>

  <Accordion title="Is the bridge key per machine or per hospital?">
    Per machine, so one compromised or replaced bridge PC never affects the others. Each row generates and rotates its own.
  </Accordion>

  <Accordion title="Is there deeper documentation on the bridge?">
    Yes — the Diagnostics edition runs the same integration, including auto-archive policy in detail. See [Modalities](/lims/imaging/modalities).
  </Accordion>
</AccordionGroup>

<StillStuck topic="a modality connection" />